Acupuncture De-mystified

Acknowledgements For the production of this book, I would like to thank my parents who have always encouraged me to use my ability / talents to help others, all the Doctors / colleagues, who have shared their knowledge with me, my good friends in Singapore (too many to name, but almost all from Raffles), and patients and friends in Australia. I would like especially to thank Kieran Davies, who showed me how to extend my help to others in a way I never thought possible, and Ms Ruby Taylor, who did the photography and video for this book as well as much more.

From Left to Right: Dr. Andrew Ling, Kieran Davies, Ruby Rose Taylor.

Contents Introduction Chapter 1: Acupuncture Theory and Common Questions Chapter 2: Research into Effectiveness of Acupuncture Chapter 3: Meridians / Channels Chapter 4: Scientific aspects of Western Medicine. How Acupuncture Compares.

Pain control, Immunity and Hormones

Chapter 5: Ear Acupuncture Chapter 6: Laser Acupuncture Chapter 7: Practical Issues, Moxibustion and Cupping Chapter 8: Extra Scientific Medical Information on Healing and Maintaining Health Chapter 9: Appendix

Confucius said: “San ren xing bi you wo shi� fs24 Translated saying: When two people walk with me there is my teacher; meaning we can learn from each other.

Introduction As acupuncture is becoming more available in Australia, people are asking a lot of questions about it.

Although brought up in the culture where acupuncture was practised, like most kids, I was scared of needles in my childhood and avoided anything to do with it. Later, trained in Western Medicine, I initially did not believe that acupuncture had any legitimate use in treating illnesses, believing as a lot of people still do that "it's all in the mind", or as the proper term is in Western Medicine, it works through "a placebo effect". This belief was widespread amongst my medical colleagues many years ago and even today a lot of Western medicine trained doctors refuse to even look at the facts on acupuncture.

The purpose of this book is to present an overview of Acupuncture and how it can relate to Western Medicine to the general public. The more technical sections could provide an introduction to the average Western trained doctor as to how acupuncture can be integrated into their normal Western Medical practice to give patients full benefit of both

systems. Details of Acupuncture points and Meridians as well as complex explanations of ancient beliefs are left out to keep the book easily readable, but links are included for further reading on these and various topics. There are lots of Acupuncture books for those who intend to study acupuncture in depth, and I encourage those interested to continue increasing their knowledge in this fascinating mode of treatment. If this stimulated interest continues and scientists continue to investigate Acupuncture with more studies, leading to more revelations and better treatment options for people, the intention of this book will be fulfilled.

My Journey into Acupuncture After graduating as a doctor at Monash University in Melbourne, Australia, I started work at the Prince Henry's Hospital. There a surgeon mentor called Mr Tim Loh went on the first Australian Medical team to China, when China opened its door to Westerners (after President Nixon's visit) to check the medical practices available to the Chinese people. He came back and told amazing stories of acupuncture practices there.

In particular, Mr Loh told of people undergoing major surgery using acupuncture and light sedation; and how the patients would walk themselves out of the operating room immediately post-operatively. Acupuncture was also widely used in China for illnesses normally needing drugs in Western countries. Mr Loh was so impressed he went on to study acupuncture and became a full time acupuncturist.

After graduation and on starting work, I was full of enthusiasm and thought I could help everyone with their illnesses. It did not take long to find out that there are a lot of patients who could undergo all available Western Medical treatments and yet have their problem(s) unresolved. Also there are a lot of patients who failed to continue their medicines due to side effects.

I initially sent my patients who failed to get adequate improvement with Western Medicine to Mr Loh for acupuncture and was impressed by the results, so I decided to look into the practice in depth. As I found more evidence of results, I felt it would be good for my patients to have an extra mode of treatment when normal Western Medicine was not adequate, that I could offer Acupuncture as well, so I did a course and have continued to keep learning as much as I can ever since.

Understanding Chinese philosophy would help understand some of the Chinese view of Acupuncture. This view sees the body as being in dynamic balance between heaven and earth. Heaven provides the air we breathe and Earth provides the food, thus combining to provide the energy needed for life. Acupuncture's most basic principle, has its basis on the Daoist belief of the body's Harmony and Balance, and the flow of Qi (pronounced Chi).

The Dao is defined as the way (or road / path) things are done. Living in harmony with the way nature works is keeping harmony with the Dao; a balance is needed. Yin and Yang are two terms used to explain this harmony. The principles proposed that the body has the ability to heal itself when the Yin and Yang are in balance. This balance of the Qi is quite complex, and the interruption of the flow of Qi will result in illness. This balance will be explained further in Chapter 1.

It is easy to get a thousand prescriptions but hard to get one single remedy. - Chinese Proverb

Chapter 1 Although a lot of people have had acupuncture treatment, many questions still remain.

Commonly asked questions are: • What actually is acupuncture?

• Does Acupuncture work? If so, how?

• Also what is acupuncture good for?

• Is it all in the mind?

• Is there scientific proof?

After reading this book you should be able to answer these questions.

When talking to a "Traditional Acupuncturist" the question of how acupuncture works is cloaked in the mysterious Qi (pronounced Chi) and how it circulates in the body along paths called channels or meridians. Overall the function of Qi can be summarised as being responsible for the body's growth and nourishment, for the maintenance of body temperature, for protection of the body, and as a regulator of all body functions.

Where the flow of Qi is interrupted pain or disease is the result. Moreover there is this interaction between Yin and Yang (Yin representing "Dark and Cold" and Yang representing "Light and Hot") which has to be in balance. Interestingly, although Yin and Yang are opposites, they exist together at all times, in that one cannot exist without the other. Imbalance, either as deficiency or excess, leads to disease.

The flow of Qi can be disrupted by physical factors like poisons, trauma and infections as well as nutritional factors (like too much 'bad food' or not enough nutritious food), external factors like the weather and emotional factors like stress, fear, anxiety, anger and grief.

Further explanations according to Traditional Chinese Medicine (TCM) get really

complicated and confusing, and includes classifying all organs as either "Zang" or "Fu"; and the interaction of the "Five Elements". Also, various schools have evolved giving slight variations in details.

The concept of the "Five Elements" of Fire, Earth, Metal, Water and Wood, is said to have originated in the Han Dynasty. The Five Elements Theory as used in TCM was formulated during the Yin and Zhou dynasties to link the body's physiology and pathology to the natural environment. These five elements are closely related to each other and influence each other in a system known as "mutual generation, mutual subjugation and counter subjugation".

The Five Elements theory has served not only to explain illnesses but also to account for how the body interacts with the natural world. In a very brief overall picture of the Five Elements, Fire implies heat, Earth implies growing and nourishing, Metal implies strength and firmness, Water implies moisture, coldness and flowing downwards and Wood implies softness and harmony. Associated with each element are Sounds, Emotions, Senses, Flavours, Climate Season and Body part.

These are summarised as follows: Fire:

Sound - Laugh Emotions - Joy Senses - Tongue Flavours - Bitter Climate - Heat Season - Summer Body Part - Blood & Vascular Tissue

Earth:

Sound - Song Emotions - Sympathy Senses - Mouth Flavours - Sweet Climate - Humid Season - None Body Part - Flesh (Body shape) Metal: (Metal white)

Sound - Weeping Emotions - Grief Senses - Nose Flavours - Pungent Climate - Dry-cool Season - Autumn Body Part - Hair & Skin Water:

Sound - Groaning Emotions - Fear Senses - Ear Flavours - Salty Climate - Cold Season - Winter Body Part - Bones & Marrow

Wood:

Sound - Shout Emotions - Anger Senses - Eye Flavours - Sour Climate - Windy-warm Season - Spring Body Part - Muscles & Tendons There is also a distinction of Zang and Fu organs in the above five elements: Fire: Zang - Heart; Fu - Small Intestine Earth: Zang - Spleen; Fu - Stomach Metal: Zang - Lung; Fu - Large Intestine Water: Zang - Kidney; Fu - Urinary Bladder Wood: Zang - Liver; Fu - Gall Bladder

The theory of the cycle among the elements is that Wood is burnt by Fire, which forms Earth, which conceals the Metal, which collects Water to help grow the Wood. Mutual generation, mutual subjugation and counter subjugation of the five elements in a "closed circle" relationship keep the body in balance. TCM uses these concepts to define disease and to explain the origin of painful symptoms and applies "appropriate treatment" to counter the Qi imbalance, either as deficiency or excess, which led to the disease.

Western medicine could not detect any consistent histological findings to state that all the acupuncture points exist. There are acupuncture points which, histologically, have collections of neurovascular bundles as well as physiologically have lower electrical impedance, but these findings are not present in all points, therefore is not always reliable as a means of confirming the existence of all acupuncture points.

The flow of Qi is another concept with no anatomical or physiological correlation. As for the theory of the five elements, that is even harder to prove. Scepticism is widespread in Western Medical Doctors, with controversies existing regarding the existence of channels and even acupuncture points. Many doctors openly disbelieve the practice as effective, calling the practice "unscientific" just because the theories are unproven and ignoring the evidence that had built up so far.

Let us not forget that it is the "Traditional Chinese Medical" theory that has been difficult to understand and prove. That concept had, over centuries, helped acupuncture practitioners to remember what points to use to treat patients successfully. Also with a set of theory, further learning and refinement was possible. One should look at the results of the treatment rather than just condemn the theory and thus disregard the practice. One should also remember that not being able to prove something exists does not equate that that thing does not exist.

For example, look at subatomic particles like electrons; for a long time electrons were assumed to exist as particles and not waves, but now a whole line of study called quantum physics has developed just to find out more, as the sub-atomic world is nothing like the "macroscopic world" we are used to.

As research went on, more questions arose and the famous "Schrรถdinger's Cat" experiment proposed. The "Schrรถdinger's Cat" theoretical experiment was proposed to demonstrate the conflict between what quantum theory explains as how matter behaves microscopically and nature as observed macroscopically.

See the following external link for details: http://en.wikipedia.org/wiki/Schr%C3%B6dinger%27s_cat

However, in more recent history, there are lots of properly conducted scientific experiments which have shown the practice of acupuncture to be effective. Some examples follow in the next chapter.

It is easy to get a thousand prescriptions but hard to get one single remedy. ~Chinese Proverb

Chapter 2 路 Experiments and Research into Acupuncture 路 World Health Organisation (WHO) Approval In this chapter we look at some of the research into determining the authenticity of acupuncture through research done to date.

Animal Experiments

Most people nowadays would frown on animal experimentation, but it does have the benefit that you cannot influence the animal into believing that what you are doing would help it.

Two animal experiments done many decades ago were performed as follows.

In the first, a rabbit is suspended by a sling. By doing this the animal seems to go into a state of trance and remain immobile for a while. A heat source in the form of a light globe, painted black so no light emits from it, is applied to the nose of the rabbit and the time it takes for the rabbit to try to kick free is recorded. This was done to several rabbits to obtain an average time they take to react.

Then acupuncture is applied to the appropriate areas and the experiment repeated and the reaction time noted. With acupuncture, the rabbits seem to be able to tolerate the discomfort for

longer before reacting.

In another experiment, two dogs were used, a normal dog and one with arthritis which would cause the dog to limp badly when walking. Both dogs were connected by tubing so that a "cross circulation" is maintained and acupuncture is applied to the appropriate points to the normal dog.

After treatment the tubes were removed and the dogs allowed to get moving again. It was noted that the dog with the arthritis managed to walk considerably better after the acupuncture treatment applied, than the other dog.

It is no longer unusual for acupuncture to be used to treat animals from pampered pooches to champion racehorses. Veterinary acupuncture is an acknowledged and respected field of veterinary medicine requiring formal training and certification in order to practice.

Modern Experiments More up to date experiments have taken place now with impressive evidence. The more convincing and sophisticated research done by reputable researchers in UK and France using MRI (Magnetic Resonance Imaging) and PET(Positron Emission Tomography) Scan have shown brain activity happening consistently and specifically in the appropriate areas of the brain when specific acupuncture points were stimulated. For example, stimulating the acupuncture points for vision activates areas in the visual cortex of the brain.

Another new technology being used in acupuncture research is called Functional Magnetic Resonance Imaging (fMRI). Using fMRI real-time changes in blood oxygen content of the brain shows up in colour coded images of areas of the brain when acupuncture points are stimulated.

Points studied included TaiChong (on the foot), Hegu (on the hand) amongst others with significant fMRI changes. After the TaiChong and Hegu points were needled, brain images showed frontal and temporal lobes blood flow and blood volume increases.

Biochemically, activation of certain acupuncture points, especially ear points in particular, have been shown to stimulate the release of Endorphins in the brain and these points are often used to help people cope with addiction.

A lot more scientific evidence is now available; for further notes on Human experimentation, read chapter six on Western Scientific methods and trials.

In Western Medicine it has been proven that although diseases, when untreated, tend to follow a general pattern of progress, they do not always behave or progress in a fixed pathway. The many

factors which can modify or influence the outcome of a disease or illness can be summarised as follows: 1) the genetic make-up of the person 2) the physical condition of the person at the time 3) physical factors like poisons, trauma and infections 4) malnutrition and nutritional factors like too much junk food or not enough nutritious food, 5) external factors like extremes of heat and cold 6) emotional factors like stress, fear, anxiety, anger and grief Western Medicine has undergone a lot of advances due to the scientific approach needed to prove the treatment methods and comparisons with other options. When faced with a medical condition, the Western Medical Doctor would treat the problem with the standard recommended regimen, generally one that has been scientifically shown to give the best response.

However, it is not unusual that despite the "scientific pedigree" behind the medications used, it can fail. If the problem does not respond, often more medications that had been tried and tested individually in a scientific manner would be added or the original medication replaced by a "Stronger" medication sometimes at the risk of bad side-effects.

Side effects from medications can be a serious problem. As people often suffer from multiple problems, different medications are needed, so not only multiple side effects can result, but the interactions between the medications used can cause even more problems.

As an example, let us take the common illnesses of indigestion, arthritis and heart disease. A fellow suffering from indigestion due to gastritis or ulcer would need an anti-acid medication; these days a "Proton pump inhibitor" could be prescribed by his doctor. If however if he also has arthritis, then an "anti-inflammatory" medicine may be prescribed, but at risk of aggravating the indigestion.

Without the "anti-inflammatory" medicine to help settle the arthritis he would become sedentary and would become unfit and gain weight in the form of fat accumulation.

If he also has a heart condition, Asprin is often added and this also will aggravate the indigestion.

But any fat excess would aggravate the heart condition too. So there is a big dilemma of how to provide him with medicines for all three disorders rather than treating just one or two.

Not only will treatment of the indigestion by the Proton pump inhibitor with the other two diseases be tricky; even just by taking the Proton pump inhibitor alone, the fellow is at risk (although not a high risk) of developing pneumonia, or Interstitial Nephritis; plus he might have impaired absorption of calcium and B12 in the long term.

In Western Medical treatments other available options include surgery and other physical treatments like radiotherapy, ultrasound and lasers but like all treatment options, success is not guaranteed and side effects are a possibility. Often too, surgery is an expensive option not just in the hospitalisation but the rehabilitation afterwards plus there are the added risks of the surgery and general anaesthetics, especially if the person had been unfit due to the illnesses.

Thus it seems sensible that when the Western medical treatment has failed, a trial of Acupuncture would be worthwhile. It was on that basis that a lot of my acupuncture patients started. Due to the fact that there are not too many "Medical acupuncturist" working in my district, I got a lot of patients referred to me when they have tried every possible Western medical treatment and their problem had persisted. It was on that basis that any positive outcome was a bonus for the patient.

The World Health Organisation (WHO) has now acknowledged that acupuncture can be used in a whole lot of conditions and has printed a list indicating their support. The list from WHO is as follows: DIGESTIVE Abdominal pain Constipation Diarrhea Indigestion EMOTIONAL Anxiety Depression Insomnia Nervousness Neurosis EYE-EAR-NOSE-THROAT Cataracts Poor vision Toothache Gingivitis Tinnitus GYNECOLOGICAL Premenstrual syndrome Menopausal symptoms Infertility MISCELLANEOUS Addiction control Athletic performance Blood pressure regulation

Chronic fatigue Immune system toning Stress reduction MUSCULO-SKELETAL Arthritis Back pain Neck pain Muscle pain Muscle weakness Muscle cramping Sciatica NEUROLOGICAL Headaches Migraines Neurogenic bladder dysfunction Parkinson's disease Post-operative pain Stroke RESPIRATORY Asthma Bronchitis Common cold Sinusitis Smoking cessation Tonsillitis

For further World Health Organization reading in regards to Acupuncture click here: http://apps.who.int/medicinedocs/en/d/Js4926e/

The physician should look upon the patient as a besieged city and try to rescue him with every means that art and science place at his command. ~Alexander of Tralles

Chapter 3 路 Yin / Yang and other terms introduced and explained 路 Introduction to Meridians including the Main & Other Channels

In this chapter, an overall view of the meridians and acupuncture points are presented. As this is not meant as a detailed text on acupuncture treatment, details of all the acupuncture points are not included. There are lots of Acupuncture texts which give detailed descriptions of all the points and their various Chinese names and anyone wishing to pursue further studies can easily find charts and texts in many larger study and acupuncture training books.

The Taoist symbol representing Yin (Dark) and Yang (light) has always been used to represent acupuncture. The symbol consists of a black and white "teardrop" entwined in a top to bottom fit to form a circle. Within each one of the bigger end is enclosed a dot of the opposite side. This symbol represents that Yin & Yang are complimentary forces and each has a representation of the other within its influence. One cannot exist without the other.

When considering the body, the front is considered Yin while the back is Yang; the lower parts of the body are Yin while Yang is the upper parts; the insides are Yin and the exterior Yang. However nothing is pure Yin or Yang; in the book called "Nei Jing" the following appears: Yang has its root in Yin, Yin has its root in Yang.

Without Yin, Yang cannot arise, Without Yang, Yin cannot be born.

Yin alone cannot arise; Yang alone cannot grow.

Yin and Yang are divisible but inseparable.

The balance of Yin and Yang can be skewed due to outside influences.

Four possible imbalances exist: 1. Deficiency Yang 2. Deficiency Yin 3. Excess Yang 4. Excess Yin These imbalances can be paired, so an excess of Yin can also simulate a Yang deficiency and vice versa.

YIN / YANG symbol of Acupuncture Traditionally, Chinese medicine recognises the circulation of Qi (pronounced chi) as well as blood within the body. The Qi runs through Channels or Meridians which are symmetrically distributed throughout the body. There are twelve "Main Channels" and eight "Extra Channels". The following is a brief guide of what is traditionally accepted as the existing acupuncture points and channels.

Most books on acupuncture would give details of each point, details which are not needed for the purpose of this book which tries to explain the practice and general theory of acupuncture and how acupuncture could fit into Western Medicine for the benefit of patients.

The main Channels are paired and named after various organs as follows. Some Channels have more than one commonly used abbreviation: Lung (Lu) has 11 acupuncture points Lu 1 starts at the shoulder and the meridian points run down the arm to the corner of the thumbnail

Large Intestine (LI) has 20 acupuncture points LI 1 starts at the corner of the index finger nail and the meridian points run up the arm to the nasolabial groove at the opposite side of the face Stomach (St), has 45 acupuncture points St 1 starts above the inferior orbital margin and the meridian points run down the front of the body to near the lateral corner of the second toe-nail Spleen (Sp) has 21 acupuncture points Sp 1 starts near the corner of the big toe-nail and the meridian points run up the front of the body to a point at the second Inter-Costal space, then down again to mid-axillary line of the sixth InterCostal Rib area Heart (H, He, Ht) has 9 acupuncture points H1 starts at the axilla and the meridian points run down the arm to the corner of the little finger-nail Small Intestine (SI) has 19 acupuncture points SI 1 starts near the ulna corner of the little finger-nail and the meridian points run up behind the arm to the back of the neck before coming forward to just in front of the tragus of the ear Urinary Bladder (UB, Bl) has 67 acupuncture points Bl1 starts near the inner canthus of the eye and the meridian points run over the top of the head to go down the back to the lateral border of the little toe-nail Kidney (K, Ki) has 27 acupuncture points K1 starts at the junction of the anterior 1/3 and middle 1/3 of the sole of the foot and the meridian points run up the front of the body to the inferior border of the clavicle Pericardium (P, PC) has 9 acupuncture points P1 starts at a spot close to and lateral to the nipple at the fourth Inter-Costal space and the meridian points run down the arm to the mid-point of the tip of the middle finger Sanjiao, also known as Triple Warmer (SJ, TW) has 23 acupuncture points SJ1 starts at the corner of the ring finger-nail and the meridian points run up the back of the arm to the back of the shoulder, to the posterior-lateral part of the neck, loops behind the ear to just above the tragus then to the lateral part of the eye brow

Gall Bladder (GB) has 44 acupuncture points GB1 starts just lateral to the Outer canthus of the eye and the meridian points run up the side of the head going behind the ear and down the side of the body and down the lateral part of the leg to a point just behind the fourth toe-nail on the side next to the little toe Liver (Liv, Lr, Lv) has 14 acupuncture points Liv 1 starts behind the big toe-nail and the meridian points run up the inside of the leg to the groin then upwards to below the breast .

There are also Eight Extra Channels, only two of which have their own specific points: Conception Vessel (Ren Mai), Front Midline Channel (CV, Ren) has 24 acupuncture points CV 1 starts in the mid-line between the dorsal commisure of the majora labia (or posterior border of the scrotum) and the anus and the meridian points run up the front of the body in the midline to just below the lower lip Governing Vessel (Du Mai), Back Midline Channel (GV, Du) has 28 acupuncture points Du 1 starts in the mid-line between the tip of the coccyx and the anus and the meridian points run up the back in the midline, over the head down the front of the face to the upper lip and ending inside the upper lip.

The other six Channels connect to other existing points of the meridians in the body. They are: • Chong Mai, Vital Channel • Dai Mai, Belt Channel • Yangchiao Mai, Motility Channel of Yang • Yinchiao Mai, Motility Channel of Yin • Yangwei Mai, Regulating Channel of Yang • Yingwei Mai, Regulating Channel of Yin Extra Points (also known as Extraordinary Points or Points outside the Meridians - PoM) These are points not within the traditional Meridians and consist of points in the Head & Neck (ExHN), Chest and Abdomen (Ex-CA), Back (Ex-B), Arm and Hand (Ex-AH) and Leg and Foot (ExLF) Other schools and investigators have added other points they find in their own work as being useful eg ear acupuncture points.(see later chapter)

"In order to live free and happily, you must sacrifice boredom. It is not always an easy sacrifice..."

Microsystems: The new concept in acupuncture is the Microsystems, which have evolved in relation to Ear acupuncture and now postulated by some acupuncture practitioners as also existing in the scalp, hand, foot and nose. In the next chapter (Chapter 4) Ear acupuncture, which has gained some importance and usage among acupuncturists, will be further explained; but there are less practitioners for the other areas.

Briefly, a Microsystem is a collection of acupuncture points within a small area of the body, which on stimulation appear to be able to set off a "reflex reaction" to various channels or organs of the body. Such Microsystems may be used in isolation or in conjunction with traditional body acupuncture for treatment of diseases. Current scientific knowledge has some evidence regarding acupuncture for ear microsystem, but the other microsystems would require a lot more scientific investigations to prove their effectiveness.

Inconsistencies with Western Medicine: In Acupuncture nomenclature, the Meridians are named after organs; this has caused confusion in Western Medicine as the literally translated organs imply anatomical & physiological functions as understood in Western Medicine. There is the obvious disagreement too that pericardium is not an organ but merely the membrane which surrounds the heart and there is no "triple Warmer" organ in Western Medicine.

Acupuncture Meridians running through the body may not have any obvious relationship with the organ represented by that meridian; eg Large Intestine and Small Intestine meridians, run along areas from the hands to the face - nowhere near the organs which their names represent. Also, Bladder and Kidney meridians run the opposite to their respective organ sites - Kidney meridians running in the front of the body, when the kidneys are situated in the back, while Bladder meridian runs in the back, and as everyone knows, the bladder is in the front of the pelvis.

However, in some acupuncture books there are "internal channels" drawn which link the appropriate channel with their appropriate internal organ. These "internal channels" add to the confusion as not all acupuncture books note their existence, and if the external channels are hard to prove the "internal channels" would be even harder.

In the next chapter further information regarding scientific methods and Western Medicine will be discussed. Meantime it is important to remember that in healing and maintaining health, a lot of complicated factors come into play as mentioned in the previous Chapter. Not being able to prove something exists does not necessarily mean that it does not exist. It is important in research and further understanding of Acupuncture to keep looking. Meanwhile, keeping a healthy scepticism regarding a theory does not mean a scientist should ignore any repeatedly and consistently demonstrated positive results by such method of treatment. Later chapters will present some evidence regarding such positive results.

There are things we know that we know. There are things that we now know we don't know.

There are also things that we do not know we don't know. - Donald Rumsfeld

Chapter 4 In depth • Scientific aspects of Western Medicine • How this relates to Acupuncture We will now look in detail the scientific aspects of Western Medicine and how Acupuncture Compares

EBM The latest "buzz-word" in Western medicine treatments is Evidence Based Medicine, EBM for short. This is a very important concept as treatments that are no better than no treatment at all can be weeded out.

This also means that if the body heals just as quickly without treatment than with treatment a lot of time and money is not wasted on the treatment. Furthermore, even if a form of treatment gives a better result, any adverse outcomes from that treatment can also be identified and the balance of risks evaluated - that is, we need to ask: is the risk of not treating bigger than the risk of instituting treatment but possibly having side-effects? This concept of "Risk" versus "Benefit" is an important concept in any medical procedures / treatments and will be mentioned whenever comparisons are made between various types of treatments.

A good example was using diuretics for treating hypertension. Many years ago, a group of diuretics called thiazides were used as "first line" treatment for hypertension. Thiazides did a reasonable job lowering the blood pressure in a lot of patients and it was a relatively cheap drug. Later it was discovered that thiazides have a long list of side-effects, like adversely raising blood glucose and cholesterol as well as dropping blood potassium and magnesium levels. It may cause headaches, confusion, muscle cramps, menstrual irregularities, adverse kidney, liver and blood effects plus making the person taking it tired and making males impotent.

Since the risks of untreated Hypertension (that is, kidney failure, heart attacks and strokes) are more dangerous, thiazides were used in high doses for many years. As better medications came along EBM suggested diuretics should only be used as an add-on drug and in as low a dose as possible. Thus patients are getting the most efficient treatment method plus side effects are minimised due to EBM. For this reason, Acupuncture should also be evaluated to be combined with Western Medicine as an extra option of treatment in appropriate instances.

SCIENTIFIC TRIALS There are many ways scientists go about investigating medical treatments. Direct comparison of various treatment options may appear intuitively to be easy to do and in fact is often quoted in nonscientific literature to "prove" one method of treating a condition to be better than another. But, often the direct comparisons are made by people with a dedication to their method of treatment, or the subjects are not standardised, for example, the condition being treated may be less severe in their subjects than those treated by another method. To be "scientific", problems of "Bias", "Self deception" or "wishful thinking" and self-validation have to be eliminated. Also 'chance occurrences', called spontaneous resolution can be identified.

Modern scientific methods are generally very strict; evidence produced needs to be "peer reviewed" and "reproducible" before being accepted by the scientific community. Tests using vague terms and use of obscure terminology which are not done in an open way, eg just based on anecdotal evidence or personal experience of one, is generally regarded as insufficient evidence of the efficacy of a treatment and may even be regarded as personal bias of that practitioner(s) and totally unacceptable.

Trials that can be done include simple observational cause and effect ones. For example, to test if a new medicinal substance called X is effective for treating Irritable Bowel Syndrome (IBS), patients can be recruited for evaluation; and pre-treatment symptoms of severity and frequency of attacks are documented. Then the treatment can be started with substance X and further evaluation done after a fixed period. Depending on whether one needed to measure for short term or long term benefits, the period of measurement can be weeks, months or years. The results can then be evaluated mathematically to check the percentage of patients who benefited from the use of substance X. The obvious flaws in such measurements are there is no accounting for patients who might have got better because of a change in diet, lifestyle or improvement in their mental, emotional or even financial problems in their lives. Also if the trial is done by a small group of investigators who have financial interests in substance X, the risk of bias would not be accounted for.

However, recent conclusions from several observational studies regarding daily coffee consumption and reduction of Type 2 diabetes has been stated as highly significant (Huxley et al, University of Sydney), so it is an accepted form of scientific assessment, if many proper trials (as explained later) are done with a big number of patients.

Medicines on the market now have to rely on solid evidence that it works and the best evidence is with Randomised Controlled Trials (RCTs) What are Randomised Controlled Trials?

RCTs are now regarded as the "gold standard" in Western Medical studies, as they are rigorous in trying to avoid bias in both the researcher and the subjects being tested. Nowadays, RCTs have been used to test all new prescription medicines before the medicines are allowed to be released for general use.

How RCTs are carried out is explained below.

Basically you need two groups of "identical" patients (the strict selection process will be explained later) one is the "test" group while the other serves as "control".

The strictest form of RCT is the "Double-blind" RCTs, where both the evaluator and the test subject will not know which item is "active" and which is "control".

In a drug RCT, where a new chemical compound needs to be evaluated, two groups of identically looking tablets will be prepared by Scientist A (and labelled say Y and Z, but only one has the active ingredient being tested) Scientist A will not have further input into who gets which tablets, but may be involved later in assessing the results.

Next, Scientist B then gives the tablets out according to a protocol. Nowadays the randomised process can be computer generated, so total 'allocation bias' is eliminated.

Selection process in RCTs Volunteer subjects are divided into two groups in a RCT and called the "Experimental" and "Control" groups, but labelled Group 1 and Group 2, due to the fact that Scientist B will not know which one is experimental or control until the code is broken during the analysis process after the trial period.

The two groups must be identical in all relevant ways (Eg age, sex, general health, etc, and must not have allergy to components in the drug being tested). Patients who agree to be in a trial are aware they are "randomly selected" as to which group they go into; in other words, in a drug-trial, they know they may or may not be taking an active drug. In a "drug comparison" study, they also will not know which drug they will be taking.

In other words, Group 1 may be given tablets labelled Y and Group 2 tablets labelled Z. In some experiments, after a period of time a "washout period" of no medication is observed and the groups given the opposite tablets after, that means Group 1 will get tablets labelled Z and vice versa. This latter method is more important in comparison of two active ingredients, where previously one may be more established and would be the standard for comparison. As you can see, RCTs are very complex and time consuming investigations, thus also very costly to run. Pharmaceutical companies who had already spent a lot of money to bring a new drug to the stage where RCTs are done would be taking a risk that the new drug may not be as good as the "standard" drug for the condition it was meant to treat. One can understand why RCT type research is lacking in nonpatent medicines generally, as once the medicines' copyright patent have expired, other companies can copy the drugs to be sold without having to go through the costly research process.

For further information regarding RCT read the Wikipedia in the following external link

http://en.wikipedia.org/wiki/Randomized_controlled_trial A RCT usually need a fairly large number of patients in the study to get "statistical significance".

"Statistical significance" is a mathematical tool to prove that the occurrence of the event is not just due to chance. For further information, Refer to Wikipedia (external link) http://en.wikipedia.org/wiki/Statistical_significance In summary the advantages and disadvantages of RCT are:

Advantages: • Ensures that individuals are allocated to the groups without bias • Minimizes unequal distribution of other influential factors • Best evidence for causality • Allows proper statistical analysis

Disadvantages: • Time consuming • Costly • Difficulty in getting sufficient participants & testers

• At times, could be limiting in findings • Possible ethical issues

Difficulty doing RCT in acupuncture In drug studies, it is easy to hand out tablets already prepared by another researcher and thousands of subjects can be recruited and followed up for months and years It would be extremely difficult to assign a large number of patients to just one acupuncturist for the trials, so, often several acupuncturists are used and tests for heterogeneity among acupuncturists in such a study would be needed. Also in doing acupuncture, the acupuncturist tend to vary the points used on different occasions, something a drug RCT is generally not allowed to do. Since there would be inconsistencies in treatments by different acupuncturists, making treatment outcomes different, larger number of subjects would help the final calculations, but cost and time would be stretched. The generally extremely expensive costs of RCTs would be a major restrictive factor of more acupuncture RCTs being done in the future. Other practical factors as described below also affect RCT in acupuncture.

As for the "Controls" in such a trial, it would be hard to hide from the "control" group that they are not getting acupuncture! In some studies done to date, "Sham Acupuncture" had been tried - in other words, acupuncture needles were placed in areas not recognised as active standard acupuncture points for the condition being treated. The problem here is, a lot of people having acupuncture may have done some reading and may be aware where certain acupuncture points and meridians are, so the "blinded" part of the study may be invalid. Also, if the acupuncturist used some other acupuncture points or meridians that are not usually meant to be active in treating the condition, some other unexpected benefit may occur resulting in indirect benefit. This possibility is due to the fact that often there are many different points available to treat one condition. One option would be to give the subject a short general anaesthetic or to use a local anaesthetic spray for every person treated and then have the area treated hidden from the subject's vision.

The local anaesthetic spray requires several minutes to work, thus would add even more time needed for the treatment. Since most acupuncture treatments require needles to be left in for some time and require multiple sessions to work, time would be a big restricting factor to recruit a large number of people in such a trial. If a trial would use general anaesthetics, other problems (in addition to again more time being needed for applying the anaesthetics) include the extra risks of general anaesthetics the subjects have to endure; plus, the unknown effect of an extra factor, that of having a general anaesthetic, influencing acupuncture means the end result might only apply to all people having acupuncture treatments under general anaesthetics. This logic is in accordance with the strictest scientific evaluation of a trial.

Another factor in Acupuncture compared with drug treatment need to be considered. Results from Acupuncture treatment tend to come on slower, but when the improvement occurs, it tends to last longer. An example to illustrate that point would be a patient with back pain due to arthritis. He can take a strong analgesic and get pain relief within half to one hour. But the pain relief would only last for several hours and return as bad as before and would need another dose of analgesic. On the other hand, the patient being treated with Acupuncture may not get any pain relief for days, until four or more acupuncture sessions had been done. But once pain relief happens, the patient could be pain free for days and after a few more acupuncture sessions even weeks or months. Thus to compare the two modes of treatment one has to allow for long term result as well as the immediate effect.

Nevertheless, scientific trials are needed to prove the efficacy of acupuncture. Future scientists may come up with cleverer and better options, (including using improved imaging scans to detect possible body changes and better ways to measure accurately the minute chemical and hormonal changes acupuncture treatment may be responsible for) but randomised controlled, not "blinded" trials need to be organised to compare acupuncture treatment with standard Western Medical treatments. Such trials are known as "Unblinded" or Open Label trials. Medical universities would be a good place to organise such trials and governments should look into financing them. The long term benefits would include better results for patients with certain conditions and might prove to be more cost effective in the long term, thus saving money for the government, possibly more so in countries with an aging population.

An example of a RCT done for Acupuncture: A RCT was done to compare a short course of Acupuncture against "usual care" for persistent nonspecific low back pain and reported in the British Medical Journal (BMJ) in 2006 (BMJ 2006; 333: 611-612). The investigators (Thomas KJ, et al) concluded that pain scores favoured acupuncture over usual care both at 12 and 24 months at a statistically significant level. Measurements of patient satisfaction also favoured acupuncture. It was commented by some that "sham acupuncture" was not used in this trial, but as previously explained, it is not easy to do so.

Clinically, effective pain control had been the main reason my acupuncture patients prefer to have acupuncture rather than simply taking analgesics over long periods in regards to chronic severe pain.

PAIN CONTROL

Pain can be defined as an unpleasant sensation potentially signalling the presence of an internal problem within the person. In dealing with pain, it is standard practice to separate them into two categories: Acute and Chronic. Acute pain is often associated with trauma or infection and the cause is usually quite obvious. Interestingly, the severity of acute pain is not always associated with severe injury, as anyone who had suffered a "paper-cut" will attest to how severe the pain is with such a small injury. Also some body parts are extremely sensitive and become very painful with minor injuries eg small grit in eye and cornea ulcers. Chronic pain is defined as any pain lasting for three months or more.

Pain is often the only motivating influence for the person to seek help, (especially if the pain is severe or persistent) or to avoid the cause of the pain, if obvious (e.g. withdrawing when being burnt). Chronic pain, however, is a complex problem and often the cause is difficult to determine, so managing chronic pain is a major challenge to the patient's doctor. Not only do patients with similar painful conditions experience pain differently, but the doctor has to be ever vigilant to exclude a serious cause for the pain.

As a simple example, a patient with a leg fracture should not be simply treated with strong analgesics alone. Therefore, as one would not simply take stronger and stronger analgesics simply to control a persistent or worsening pain and not look into the cause of the pain, the doctor need to try to fix that background problem as well. Similarly, an acupuncturist should not start treating pain, especially chronic pain, as an isolated problem in a presenting patient without checking for the underlying cause of the pain.

Chronic pain also has a strong psychological and emotional effect on the sufferer and may not respond to any one single form of treatment. Thus the impact of chronic severe pain on a patient's life would also need treating, like sleep and mood disturbances, anxiety, depression, other psychosocial problems, co-existing conditions, etc. It is for those reasons that Western trained doctors have the scientific training and are good at diagnosing the cause of a pain problem and are able to

deal with the associated problems.

Western Medical Theory of Pain Control by Acupuncture Scientific research to date done in various countries have confirmed that acupuncture definitely works in controlling a lot of painful conditions. Part of the pain control is the confirmed release of Endorphins when some acupuncture points are stimulated. Other scientists had proposed that Acupuncture may also work by activating "inhibitory cells" (within the spinal cord) which in turn inhibit the activation of "transmission cells", also in the spinal cord. An injury to the body would start a signal via nerve fibres to both the "transmission cells" and the "inhibitory cells", and then signals go up the spinal cord to the brain.

As pain is felt when the output from the "transmission cells" exceed a critical level, they are regarded as opening the "gate for pain"; conversely, the higher input from the "inhibitory cells" can be regarded as shutting the "gate for pain". (This explanation is according to the established Melzack and Wall's "Gate Control" theory of pain). More than simple pain relief, acupuncture has been shown to help improve some of the conditions that caused the pain in the first place, eg migraines, thus eliminating the need to continue taking analgesics.

IMMUNITY AND HORMONAL BALANCE ISSUES The body's immune and hormonal systems are very complex systems. The immunity of the body acts to stop any foreign substance from invading the body. Some of these foreign substances eg bacteria and viruses have managed to overcome the body's immune system causing illnesses. If the immune system can be made stronger so as to get rid of the foreign substances quickly, or cleverer at identifying the foreign invaders before they have a chance to consolidate and multiply, the body will have a chance to defeat them quickly. But there are many factors that impede the body's immune system; a weakened immune system is called immunodeficiency.

Immunodeficiency may be inherited in some rare instances (some examples are Severe Combined Immunodeficiency, Wiskott-Aldrich Syndrome and Complement Deficiencies) and should be dealt with by specialists in immunological disorders urgently for proper diagnosis and management. The very young and the elderly both have weaker immune systems, but other factors including malnutrition, including the lack of micronutrients, sleep deprivation, stress, certain drugs and poisons plus infections also can weaken our immune system.Interestingly, overeating, especially when it leads to obesity and or diabetes can adversely affect the immune system as well.

Another way the immune system malfunctions is an over-reaction or hypersensitivity.

Hypersensitivity can be mild as in an allergy reaction to pollens or severe as in an anaphylactic reaction, which, if not treated quickly, can lead to death. (In a sense the Yin and Yang balance of the TCM thinking appear to fit in the body's own need to keep a balance of too little versus too much.) Autoimmune diseases and cancers are another result of the failure of the immune system.

In basic terms, Autoimmune diseases happen when the body's immune system fails to recognise some of the body's own healthy cells and start to attack them as foreign cells.

Some examples of Autoimmune diseases are: Hashimoto's thyroiditis, Lupus erythematosus, Rheumatoid arthritis, Ankylosing spondylitis, Rheumatic fever, Multiple sclerosis, Dermatomyositis, Sjogren's syndrome, Myasthenia gravis, Grave's disease, Pernicious anaemia, Type I diabetes, Autoimmune thrombocytopenic purpura, Ulcerative colitis, Giant cell arteritis and lots more For more information look up the following external link:

http://www.nlm.nih.gov/medlineplus/autoimmunediseases.html Cancer is an extremely complex topic as it concerns / involves Genetics, foods, hormones, infections, poisons, chemicals and other environmental factors and the immune system.

Simplistically, it can be considered as a failure of the body's immune system. In the normal course of the body replacing and repairing cells, abnormal cells can form. (Abnormal cells can also develop from certain infections and repeated damage from chemicals etc). If these abnormal cells start to multiply uncontrollably, they are called cancer. The immune system can normally detect these abnormal cells and get rid of them before they get dangerous to the body; but when the immune system fails the cancer cells can damage the part of the body they are in as well as spread to other parts of the body causing widespread damage.

Ways of improving the body's immune system include "healthy practices" (see Chapter 8) as well as having vaccinations against any "invaders". There are acupuncture points which allegedly help in some infections and in the treatment of allergies, so the possibility that Acupuncture can act to

enhance the body's immune system need further confirmation; this would be a good area for further scientific research.

Hormones

Hormones are chemicals made by the body to work as a catalyst for other bodily chemical reactions. Hormones are classed into two categories: Steroids and Peptides. They are responsible for all bodily functions from metabolism to growth, sexual function and reproduction to moods.

Hormones are normally regulated in the body by "feedback loops" to maintain the hormonal levels to a steady state; when the serum concentration gets too high or too low an illness results. To maintain this equilibrium the body has to control the rate of production of the hormone, the rate of delivery to the "target" organ or cell and the rate of elimination of the hormone.

Hormones are very important chemical messengers made by various cells in the body often grouped together in a gland. Such hormones are secreted to be circulated in the blood stream to reach a "target cell" where they act as a signal or catalyst for changes to happen. Often there is a feedback loop where the "target cells" release chemicals (or other hormones) in response to the hormone and these chemicals travel in the blood stream back to the gland that made the hormone to alter the release of further hormones. If the response is to lower the further release of hormones it is called a "Negative feedback loop"; but if it prompts more release of hormones it is a "Positive feedback loop".

Hormones are generally very powerful chemicals, with only small changes in the circulating levels needed to make big changes in the body.A good example of a biofeedback loop is as follows: the Hypothalamus, Pituitary and Thyroid glands are involved. Thyroid Hormones, made and secreted by the thyroid gland, are needed by every cell in the body to function; the lack of Thyroid Hormones can cause a serious disease called Hypothyroidism, which in the severest form can lead to Myxoedema Coma and death.

The Hypothalamus & Pituitary Gland are located at the base of the brain; the Hypothalamus secretes Thyroid releasing Hormone (TRH) which stimulates the Anterior Pituitary to secrete a hormone called Thyroid Stimulating Hormone (TSH). The Anterior Pituitary also makes other Hormones like Human Growth Hormone (HGH), Adrenocorticotrophic Hormone (ACTH), Melanocyte-Stimulating Hormone (MSH), Luteinising Hormone (LH), Follicle Stimulating Hormone (FSH) and Prolactin (PRL); while the Posterior Pituitary Secretes Oxytocin and Antidiuretic Hormone (ADH).

TRH works on the Anterior Pituitary Gland to secrete TSH which in turn works on the thyroid gland to stimulate the synthesis and secretion of Thyroid Hormones In the case of Hypothyroidism, the Hypothalamus detects the low Thyroid Hormone levels and would release more TRH stimulating the Pituitary Gland to increase TSH production and secretion.

If the Thyroid responds to the increase of TSH, then an increase of Thyroid Hormone will be detected by the Hypothalamus inhibiting TRH release and the Pituitary Gland will slow TSH secretion back to a normal level. On the other hand, if the Thyroid produces too much Thyroid Hormone, resulting in a condition called Hyperthyroidism, the Hypothalamus would detect the high Thyroid Hormone levels and reduce TRH, in turn causing the Pituitary Gland to reduce TSH secretion, with the result that the Thyroid Gland would reduce its Hormone production.

This is what is called a Negative biofeedback loop. Unfortunately, in diseases of the Thyroid, where either too little or too much Thyroid Hormone is produced, the Thyroid may not respond appropriately to TSH and will continue at its abnormal production levels. In another disorder, as in a Hormone producing tumour in the Pituitary gland, the increased TSH production causes the thyroid to produce and release more thyroid hormone but the increase in Thyroid Hormone will not result in a reduction of TSH production.

For further reading on Hyperthyroidism see:

http://en.wikipedia.org/wiki/Hyperthyroidism Some hormones can also be considered as immunomodulators of the immune system.

Immunomodulators are substances which can affect the immune system by stimulating it (immunostimulation) or by suppressing it (immunosuppression).

Dehydroepiandrosterone (DHEA), which is produced in the adrenal glands, is one hormone considered to have immunomodulators properties. Falling levels of DHEA in the elderly has been implicated in the development of some malignancies but high dosage intake of DHEA supplements are considered risky for prostate and breast cancer. So too little or too much DHEA appear to act as immunomodulators of the immune system.

Drugs have been available in modern Western Medical science proven to act as immunomodulators.Examples of substances and drugs which can cause immunostimulation are: BCG; Levamisole; Cytokines; Thymosin, Azimexon, and other drugs. Examples of substances and drugs which can cause immunosuppression are: Cytotoxic agents like Methotrexate, Azathioprine and Cyclophosphamide; Prednisolone; Tacrolimus; some antibodies; Sirolimus (and other drugs used in organ transplantation to stop rejection) and Interferons

It is also known that some drugs can have both immunostimulation and immunosuppression properties on different receptors within the immune system.Cytokines are another group of body glycoproteins which has immunomodulatory effects, chemicals.

Due to the fact that Acupuncture has now been proven to release brain endorphins, there is the possibility that acupuncture may also alter hormone release and even production. As mentioned before, Hormones being powerful chemicals and only small amounts can alter body functions in a major way, improvement in measuring minute Hormonal changes in the blood, as scientific research advances, may clarify how acupuncture works.

Heat Stressed Proteins (HSP) These are a class of proteins which are present in all living organisms. HSPs come in various molecular weights and for convenience are named after their weight (eg HSP60, HSP70, HSP90 etc). HSPs help the body's repair system as well as help the body's immune system. When stressed, eg from infection, starvation, exposed to toxic substances, etc, the body appears to produce more HSPs. Some studies have shown acupuncture to upregulate some HSPs; this could also be another area of how acupuncture works in helping the body fight diseases, but further studies which are under way are needed to further clarify the situation.

Scientific studies are showing how complicated the body system is. Measuring long term beneficial effects of acupuncture had always been difficult; as acupuncture may have a "latency effect" any measurements of short term changes may not prove the benefits of acupuncture treatment. I hope more studies with a longer time frame will clarify the situation. At present, the language used in Eastern Medicine's acupuncture has made it more difficult to reconcile the use of acupuncture within Western Medicine. With more scientific studies, this would help the integration of acupuncture.

"In order to discover things, one must be ignorant. A discovery is rarely logical and often goes against existing conceptions" - Claude Bernard

Chapter 5 EAR ACUPUNCTURE

Auriculotherapy or Ear acupuncture is the use of acupuncture, or other stimulation, at ear points to treat symptoms or problems in the whole body. As most people regard the ear as only having the function of hearing, ear acupuncture is even more difficult to conceptualise as a treatment modality for illnesses over the whole body. Again there is no evidence in "Western Medicine" books of any anatomical or physiological connections between the ear and other organs in the body, but the history of ear acupuncture is fascinating.

HISTORY Although Auriculotherapy does not have as clear a recorded history as body acupuncture in China, ear acupuncture points have been clearly noted in ancient Chinese texts. Interestingly, on the other side of the world, there are documents that the Greek physician, Hippocrates, reported on the practice by ancient physicians of cutting the veins behind the ear to treat sciatic pains and to reduce impotence and ejaculation problems.

In ancient China, ear acupuncture points were not arranged in any anatomical pattern, but scattered in no obvious logical order. As mentioned in the introductory chapter's "Brief History Of Acupuncture", the practice of acupuncture was introduced to Europe by early travellers and further developed.

It was a Dr Paul Nogier in France who noted scars in the upper ears of some patients who had been treated successfully by another "practitioner" for sciatic pain by cauterising those areas. Dr Nogier did further studies using acupuncture and worked on the theory that if one area of the ear can treat low back pain, other parts of the body may be similarly treated at other areas in the ear.

After a lot of studies, he later proposed the "inverted foetus" pattern on the external ear in the 1950's and wrote papers which later was published by a German acupuncture society and passed on to Japan. The information got over to China and was adopted by China's acupuncturists who carried out further studies that verified the effectiveness of the "inverted foetus" map. This resulted

in a renewed huge movement to study and use Auriculotherapy to treat illness from around 1958, leading to acupuncturists using Auriculotherapy alone to treat certain medical conditions. One such success is in the treatment of Opium and Heroin addiction, where the method used has been adapted into some Western Medical practices to treat similar addictions.

Dr Nogier went further in his studies of ear acupuncture and wrote a book "The handbook to Auriculotherapy" in 1968 and "The Treatise of Auriculotherapy" in 1972. He also taught his Auriculotherapy methods widely.

The World Health Organisation held a meeting on auricular acupuncture nomenclature in Lyons, France in 1990 in honour of Dr Nogier's pioneering discoveries.

The "inverted foetus" pattern proposed by Dr Nogier and the present day presentation of how the "inverted foetus" pattern has been modified and adapted is illustrated in the following pictures: Ear and "inverted foetus" images

Present day theory of Auriculotherapy states that the ear is a self-contained "microsystem" and not directly related to the Channels in the rest of the body. There is a way to measure the abnormal

functioning of an internal organ as represented by the "inverted foetus" pattern on the external ear - the method is electric conductance testing.

In electric conductance testing, higher skin conductance (due to lower electrical impedance) can be found using electronic equipment at the appropriate points corresponding to the pathology of the appropriate body organ. As the body organ recovers, the skin conductance at that ear point returns to normal. This can happen quickly in some (but not all) patients being treated with acupuncture who would report at the same time that the pain they had felt before treatment has improved - one way of proving the therapeutic efficacy of ear acupuncture.

Locator used to find points of lower electrical impedance Caution: At present, electric conductance testing to identify problems within an organ has not been proven in Western Medicine as a definite diagnostic procedure. The points identified by the locator are indicators to be alert and should prompt the acupuncturist or doctor to check the organs involved. An alert may not mean a disease process and the reason for the points to have lower electrical impedance is not clear, but vigilance is needed to prevent missing a developing problem.

In this way, patients may benefit from the early detection of illnesses, some of which can be treated very successfully if discovered in the early stages.

On the other hand, it should not cause alarm to patients and produce unnecessary anxiety; if used by practitioners who do not have adequate training in body function and illnesses as well as not having a good knowledge of acupuncture, a wrong interpretation will be given to patients and easily can cause stress and anxiety. (Read also Chapter 7 on Stress and Anxiety) Auriculotherapy can relieve some pain problems quicker than body acupuncture, and is also very versatile in that it can be done at the same session as body acupuncture. The problem is ear needling tends to be a bit more painful than body needling; also some after treatment persistent pain can occur. With ear needling, tiny intra-dermal needles which look like thumbtacks with a sticky tape backing attached can be used and left in position for several days.

For certain treatments this way can provide continuing treatment over days with more steady improvements, a good example of this method of treatment is for drug addiction.

It has been established that Auriculotherapy, as in body acupuncture, can raise endorphins and encephalin (a sub-fraction of endorphin) levels in blood and in the Cerebrospinal fluid (CSF), these biochemical substances are the body's own pain relieving chemicals. Another possibility of how Auriculotherapy may work is the likelihood that ear acupuncture may activate nociceptors in the skin. Normally such nerve receptors become activated by actual tissue damage which results in release of chemicals like histamine, bradykinin, prostaglandin etc, so that the body can react appropriately including starting repairs.

The theory of "Microsystems" in the ear has been hard to explain. One theory compares it to our memory system where memories are not in several neurones or groups of neurones but in patterns of nerve impulses that crisscross the brain. In such a model, there is not just a single track to activate our memory, but multiple ways can do it. Other theories had been postulated, but as they are quite complex and had not been proven in Western scientific ways, it will not be discussed in this book. Microsystems are supposed to exist in other parts of the body including the hands, feet, tongue etc.

A Professor Ming Qing Zhu who graduated from Shanghai University and is a well known acupuncturist has written a textbook on scalp acupuncture and had lectured all over the world. He had used scalp acupuncture to treat a lot of spinal cord injury patients.

Other acupuncturists have been working with a concept of hand, feet and nose microsystems using Acupuncture on just those limited areas to treat disorders. These methods of treatments need a lot more scientifically conducted RCTs to provide evidence of efficacy.

General image showing the anatomy of the ear

There are two kinds of light - the glow that illumines, and the glare that obscures.

- James Thurber

Chapter 6 Laser acupuncture With modern developments in science, especially in Laser technology, Laser acupuncture is getting used more, especially for patients who fear needles. Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Laser beams are high concentrations of energy in a narrow beam of monochromatic light which had been used increasingly more in medicine as well as industries, the military and other everyday technologies. Lasers are now commonly used in medical equipment for diagnoses, in surgery especially for eye and plastic / cosmetic work, and in acupuncture. There are two classifications of such laser equipment, the high powered and low powered groups. High powered lasers can cause tissue damage after absorption by the body and converted into heat. Low powered lasers, as used in Acupuncture equipment, however, are only supposed to raise the affected areas' temperature by less than 0.5 degrees Centigrade.

In Laser acupuncture treatment, low energy laser beams are used instead of needles on the acupuncture points. Laser beam penetration of the skin is affected by skin pigmentation, the amount of fat under the skin as well as any tissue swelling or inflammation of the area being treated. Lasers commonly used are in the 5 to 500 mW range, (Termed Class lllb lasers) in the red beam range of 600-700nm and in the infrared beam range of 800-1000nm. The red beam laser has a shallow penetration range of less than 1mm, but the infrared Lasers can penetrate considerably deeper, reported as 20mm or slightly more.

The rise in temperature at the points affected by the Low energy Laser Beams may add another dimension to how laser works at acupuncture points. The theory is, there is a possibility of the raised temperature causing improvement in the microvascular circulation and in the cells' function.

Some people have compared this raised temperature to Moxibustion treatment in TCM, again a theory rather than a proven fact.

Modern Laser acupuncture can be done with Laser pens offering continuous and pulsed modes and running on small batteries. The beam of light emitted is of small diameter, around 1mm. The small size and weight makes it convenient to carry the equipment anywhere to be used.

Laser acupuncture has now been used for Carpal tunnel problems, elbow pains eg from "tennis elbow", scalp, head and neck problems especially in headache treatment. Laser acupuncture has also been used for stroke patients with paralysis. But other practitioners are trying Laser acupuncture for more extensive conditions including promoting wound and burns healing, improving scar tissues, improving localised circulation, treat shingles skin infections and even some chronic arthritic problems in the smaller joints, but as a relatively new modality, not much direct comparison studies with needle acupuncture is available.

Laser acupuncture is popular among veterinary acupuncturists because animals are unlikely to keep still during treatment, making it difficult to maintain acupuncture needles in position.

Advantages Advantages of Laser Acupuncture are they are non-traumatic thus not painful during treatment.

Also as the skin is not punctured it is aseptic and safer in areas where the risk of infection is high.

Also in areas where there is a collection of fluid or lymph (a condition called oedema) needling would be contraindicated and Laser is preferred. Laser acupuncture is preferred by children and people with a needle-phobia. Laser acupuncture tends to be done quicker in that the points are stimulated for only seconds to about a minute each, depending on how powerful the laser unit is.

Laser Acupuncture Pen

Disadvantages.

There are known disadvantages with Laser Acupuncture as well. Limited to more superficial points, laser acupuncture does not appear to treat deeper points as well as traditional needling. Such deep points are especially located in the back and abdomen. Also during the needling process in acupuncture, the patient often can tell when the acupuncture point is activated, this direct feeling and ability to stop exactly at the "active acupuncture point" is not available using Laser beams and also administrating the appropriate dose of laser appear to be important to achieve any effect. At the present, not enough research has been done to determine the ideals of Laser treatment, eg the

best wavelength to use, dose needed and the length of treatment. The safety of Lasers is often neglected due to the widespread use of the technology. Even low powered lasers of a few milliwatts power output can damage the retina if a laser beam hits the eye directly or even from the reflection off a shiny surface. If the beam of laser fits the wavelengths that the lens of the eye can focus the beam the danger of damage is even more severe and can happen in seconds. Class lllb lasers are generally considered dangerous to the eye with immediate damage possible on exposure. (Class lV Lasers are even more dangerous, not just in eye damage but can burn the skin.)

Other than eye damage, Laser acupuncture may actually cause more pain after treatment as well as cause nausea, dizziness and even fainting. Lasers capable of deeper penetration should be used with extreme caution or avoided altogether when organs are located under the treated area.

Further caution is needed when flammable gases (including anaesthetic gases oxygen and alcohol swabs) are around as a fire can result if the laser beam is activated with the gas present.

Poisons and medicine are often times the same substance given with different intents. -Peter Mere Latham Chapter 7 Acupuncture Needles:

Acupuncture needles are very fine ranging from gauges 26 (diameter 0.45mm) to 32 (diameter 0.26mm); they have rounded tips (instead of a "cutting edge" which injection needles have) so that during insertion into muscle fibres the needle would part the fibres rather than cut them. Modern needles are made as single use stainless steel disposable needles which come pre-sterilised.

They can vary in length depending on which part of the body it is used for - from less than1cm to 10 cm long. Ear needles and intra-dermal needles are smaller still and can come in a form like a small pin or thumbtack.

In the past there are "multiple needles" attached to a long handle being used. These are called "plum-blossom needles" and was used to tap certain points on the meridians. Due to the risks of cross infection from bleeding such needles are not commonly used by Western medicine trained acupuncturists.

Needle insertion is usually painless or only associated with slight pains, no worse than a mosquito bite. The sensation felt, traditionally regarded as the arrival of the Qi, may vary from minor ache, tingling, distension, warmth or "heaviness". However, rarely it can be fairly painful and the needle can be just left without further stimulation until the pain settles or it may have to be withdrawn and another point chosen. A "tense' patient can sometimes be the reason for the pain, but pain can also

result if a nerve ending or small blood vessel is needled. The method of needle insertion is also important in avoiding pain and I have now used needles with a guide tube to reduce pain.

When treating a person with acupuncture, the acupuncturist should consider the "whole person" It is generally not acceptable practice to just stick needles in all the painful points (Ah Shi points) or to use too many needles at once, As a general rule I start with fewer needles and use the distal points first. Then other points on the meridians affected may be added.

There are some people who are very sensitive to acupuncture needling and they need to be treated more gently, with minimal number of needles as well as the frequency of sessions. They are often referred to as "quick responders" and they can get better in much shorter times than the average person.

Then there are some patients who seem "resistant" to acupuncture treatment. If they have no response after five or six sessions one may have to accept that you are treating such a person. But there are also "slow responders" who would respond, but takes a lot more treatments than average, so it can be confusing.

Adding to the confusion let me give an example of treatment of headaches using acupuncture.

Recorded in various textbooks are points which can help different types of headaches. All the following Channels have points which can be used: Lung, Large Intestine, Small Intestine, Bladder, Triple Warmer, Gall Bladder, Liver, Governing Vessel (Du Mai) and extra points - all together totalling more than 50 points!

To the inexperienced acupuncturist, the choice of points may get too complicated, so it has been known for some to "put in needles everywhere". This is where cartoonists have a field day drawing people looking like porcupines when having acupuncture.

Actual cases of acupuncture treatment The following are a few examples from patients treated by me in the past to show what acupuncture can achieve.

1) Patient with severe migraines I can still remember vividly a lady in her early forties who had the most severe migraines imaginable. She was sent to me by a colleague I met at a medical function; he asked if acupuncture can help his patient with migraine problems, so I innocently agreed to try.

Classical migraine is not just a severe headache; a migraine generally affects one side of the head and is associated with nausea, vomiting and light sensitivity (called photophobia). Also migraine sufferers can have headaches triggered off by loud noises, extreme temperatures, dehydration, glaring lights, head and neck injury, exhaustion, stress, sleep disturbances, internal hormonal changes, some foods including food additives, caffeine, cheeses and chocolate, alcohol and even certain odours among other things.

In essence this poor lady had a migraine attack at least once a week, more often twice. Most attacks would last two to three days, with the headache so blindingly severe she had to spend days lying in a darkened room hanging on to a bucket and would call her doctor for a Morphine injection on a regular basis. These attacks had been happening for more than three years and she had all sorts of investigations done and had seen a range of specialists, including neurologists, neurosurgeons, rheumatologists, psychiatrists / psychologists and so on. Naturally she had also gone on her own accord to see all the "alternative therapists" under the sun (except acupuncture) and tried everything suggested - all with no benefit.

When I first saw the lady my heart sank; I am always prepared to help someone in trouble, but I felt quite disheartened before I started treatment, because not only the severity of the problem is extreme, but I was worried that it might take a long time before any result would eventuate. I did my usual explanation to her about acupuncture treatment and how she may need a lot of treatments as her problem was so severe, making sure that she did not develop false hope only to feel even worse if treatment failed. Amazingly when she returned for her third acupuncture treatment, she reported all her headaches had disappeared and she felt the best she had for years! She had also gone back to doing all her housework, including vacuuming which previously had not only aggravated her migraines but can start one.

As that patient had to come a long way for treatment, I told her to return for more treatment only if her migraines returned rather than continue treatment when she is already migraine-free. She has not returned to have further acupuncture treatment.

Obviously there is no guarantee that every patient with migraines will have total resolution with acupuncture treatment. However the case of this patient, illustrates how acupuncture may have helped her get rid of her migraines much earlier if she had tried acupuncture sooner.

2) Patient with severe back pain due to secondary spinal cancer This elderly lady had been diagnosed with secondary spinal cancer and was in a lot of pain. As mentioned in Chapter 3 control of severe chronic pain is a huge challenge to doctors. In this lady's case, her pain can only be controlled by morphine. As time went on, her morphine need became more and break-through pain was still present. Her husband noticed that with higher and higher doses of Morphine, his wife was getting very lethargic and drowsy and the pain was still present.

Knowing that even higher doses of Morphine would make his wife totally bed-bound, he asked me to try a course of Acupuncture as he himself had had good effect from acupuncture treatment in the past. Amazingly, Acupuncture worked so well, she actually started reducing her dose of morphine and ended up not needing any Morphine in the day, using the occasional one some nights only, and managed to go out shopping again with her husband.

3) Lady with Disc protrusion in the spinal cord A middle aged lady with a back pain problem brought in her CT Scan report on her back. The scan was ordered by her rheumatologist as she has symptoms of a prolapsed Lumbar disc. The scan confirmed a large prolapsed Lumbar disc which was irritating the nerve and she was booked to have an operation. However she did not have health insurance and the wait for a public hospital bed was about a year. She had waited over six months and was getting upset at the constant pain, as she used to be quite an active person including doing bike-riding. So, as an interim measure, she wanted to try acupuncture to get some pain relief. I started her on Acupuncture and after a slightly prolonged treatment of almost 20 sessions she was very happy that the back pain had settled. When the hospital wrote to tell her that her back operation is coming up, she went back to see her rheumatologist, who thought a further scan would be needed. She came back later to advise that her rheumatologist had phoned her to tell her to cancel her operation as the prolapsed disc appeared to have gone back to normal! Some time later she came and told me she had gone back doing her bike-riding and was enjoying herself.

4) Elderly man with knee arthritis An elderly man in his mid seventies was suffering from severe knee arthritis with pain restricting him to very little walking. After a course of acupuncture treatment, his knee pain went and he went on to mow his lawn. Because he had not done his lawn for a long time the grass was thick and almost knee high. He persisted pushing his lawn mower and aggravated his knee arthritis in the end. The moral of this story is I now always warn patients not to do anything he/she could not do before acupuncture treatment for at least several weeks after any pain relief, but to gradually introduce activities over weeks or even months depending on the severity of the initial problem.

5) Young lady with ovarian cysts A young lady with lower abdominal pains was seen by her gynaecologist and had an ultrasound scan which showed she has lots of cysts in one of her ovaries. She was informed by the gynaecologist that an operation may help but there is a chance of recurrence meaning repeated operations in future was probable, As an interim measure, she wanted to try acupuncture for pain relief. She completed a course of acupuncture with substantial pain relief and some months later as her pain had not returned, I ordered a repeat ultrasound scan to check on her ovaries.

Unexpectedly, the diseased ovary had returned to its normal size and the previous cysts appeared to have gone away.

6) Couple who wanted to stop smoking.

A middle aged couple wanted to stop smoking but had tried a lot of methods without success. I started them on some counselling then added ear acupuncture and within four weeks, they both became non-smokers. I found a combination of counselling and ear acupuncture a satisfying way to help people addicted to smoking.

Risks and "Side Effects" As in any treatment modes, it is important to consider the question of: "what about Risks and Side Effects?"

The following is a short list of the commonest "risks and side effects" of acupuncture treatment: • Pain • Mechanical trauma, Nerve damage, Organ damage • Overt bleeding and bleeding under the skin causing haematoma

• Thrombosis and pseudoaneurysm • Infection and cross-infection • Dizziness, Nausea and vomiting • Loss of consciousness When practised by a careful, expert acupuncturist, risk of any injury is extremely small.

The commonest side effect is probably the "needling pain" factor which is always aggravated by anxiety, especially in patients who has a fear of needles. This is where a proper explanation of the process, with appropriate reassurance as well as the manner of the acupuncturists and the acupuncturists' technical expertise will make a big difference.

Generally a trained acupuncturist should know to avoid penetrating internal organs. In particular puncturing the lung could result in "pneumothorax" (collapsed lung) and an emergency trip to a hospital. Puncturing a large blood vessel can also result in a huge bleed or bruise, especially if the person happens to be on an anti-coagulant eg aspirin, clopidogrel, prasugrel, or warfarin. Even puncturing a smaller artery or vein can cause quite severe bruising or the formation of a haematoma if an acupuncturist is not careful. Damaged arteries can also form pseudoaneurysms.

Thrombosis or clotting in a vein can happen if a vein is badly damaged or if a haematoma compresses the vein and closes it.

Infection is always a risk whenever the skin is punctured on any occasion; Hepatitis and HIV are the two most serious infections in such instances but other skin and deeper infection may happen if inappropriate needling is done. Again a careful, acupuncturist would try to eliminate all possibility of such infections. Regarding antiseptic precaution, there is the issue of wiping the skin area with alcohol before needle insertion. There had been studies that showed no difference between prewiping a skin area with alcohol or simply making sure the skin area is clean in regards to simple skin infections when injections are given. I believe that "double insurance" is prudent in this instance and prefer to use an alcohol swab to wipe the skin area. More than just wiping the skin, I make the extra effort to check the swab after, and if it looks unclean, I would do the area again after it has dried. Then I would wait at least a full minute (meanwhile getting other things ready) before I would insert the needles, using a "non-touch technique". In theory, germs are not instantly killed when in contact with the alcohol and also if the alcohol has not evaporated, needle insertion will introduce a minute amount of alcohol, enough to cause pain. I have never had a patient with the complication of infection caused by acupuncture done by me.

Fainting, dizziness, nausea, vomiting, palpitations and feelings of anxiety can also occur and needs to be treated appropriately. Fainting in particular can occur suddenly, so a patient having treatment sitting down might fall out of the chair.

Occasionally, after a session of acupuncture, especially if a patient had been lying down for the treatment, the patient can be so relaxed that on getting up quickly may also cause the patient to feel faint. So after a patient has finished acupuncture treatment, always be careful on getting up from the supine position, to sit for a short time first, and if feeling faint may need to lie down again for a short time.

Other risk factors include lack of concern or understanding of the patient's existing medical problems resulting in aggravation of those conditions. Examples are patients with: • Asthma or Chronic Obstructive Airway Disease (COAD) • Angina and Cardiac conditions causing chest pains • Hypotension • Illnesses needing certain medications It is therefore important that an acupuncturist treating patients with breathlessness, chest pains or patients with past histories of feeling dizzy or faint be thoroughly assessed by a medical doctor first. Further precautions are needed by an acupuncturist to prevent: • Misdiagnosis • Patient stopping their appropriate medical treatment • Aggravation of a condition being appropriately treated by a medical doctor • Failure to identify conditions requiring referral • Failure to offer timely medical treatment for serious conditions • Failure to identify adverse reactions and take appropriate remedial action • Inappropriate, ineffective and unnecessary treatment

The safety of Acupuncture in general so far compares very favourably with other treatment options.

Compared with other forms of treatment, one must not forget the rare but recorded cases of the wrong limb removed at surgery and the patients who died from anaphylactic shock after being administered drugs they are allergic to. Then there are the less serious but ever present side effects of all medications including herbal products.

Assessing the safety of drugs depends on three factors: 1) the frequency and severity of any adverse event, keeping in mind that rare but relevant events may not show for some time 2) the quality of any research done plus any ongoing monitoring being done, and 3) the risk / benefit balance for individuals Some examples regarding drugs are worth further discussion.

In particular: Most arthritis medications, belonging to the class called Non-steroidal Anti-Inflammatory Drugs (NSAIDs), tend to put the patient at risk of gastro-intestinal bleeding. NSAIDs also have a negative impact on hypertension and Asthma. They may cause rashes and other skin problems, headaches, dizziness, fluid retention and interact with a lot of other medicines. Despite that NSAIDs are widely used because they do work in the control of inflammation and pain in arthritic joints. Even the newer class of anti-inflammatory drugs called "COX-2 Inhibitor" drugs can cause gastro-intestinal bleeding though less likely than the normal NSAIDs Another group of drugs called Proton Pump Inhibitors (PPI) which have the property of reducing gastric acid production massively, are used to prevent upper gastro-intestinal ulcers and bleeding and have been extensively combined with NSAIDs to protect against GI side effects. Since PPI's introduction in 1988, they have saved millions of lives and reduced the need for surgery for further millions and PPIs are considered as one of the safest drugs around.

More recently however, PPI users seem to be more prone to develop Osteoporosis (and bone fractures) as well as Interstitial Nephritis. These side effects are considered rare and PPI medicines are regarded safe drugs. Because some side effects are uncommon and needed a long time to develop "post marketing" safety surveys need to be done for many years if not decades. In this regard, Acupuncture has a good safety profile over a history of practice unmatched by any drug treatment.

Moxibustion and Cupping

Traditionally Moxibustion and Cupping are 2 other methods of treatment in TCM closely associated with acupuncture.

Historically, the beginnings of Moxibustion has a different origin from acupuncture, and not linked at all to meridians or acupuncture points. It was simply an observation that heating up a local area can provide pain relief from some conditions. Following from the crude way of just getting near an open fire, smouldering leaves and branches were used, and the warmth generally in a cold night or in a damp environment especially in winter must produce some positive results. Cauterisation was refined to close wounds and control infected sites as well. With further testing and studying the refinement of different herbs being used.

In today's practice, Moxibustion is a treatment form by burning "moxa-wool" heaped into a small cone on the skin over certain points along the meridians. Such burning is supposed to remove obstruction of the channel being treated and eliminate "cold" and "damp" from the patient.

Moxibustion can also be done after an acupuncture needle is inserted, by burning the moxa on top of the needle handle. Moxa is made from Mugwort rolled into little cigar-like rolls which burns slowly, but lets off a smell some people have compared with burning marijuana.

Moxibustion can be painful and can leave burnt scars over the area treated. To avoid direct burning, a slice of garlic or ginger can be placed on the skin before the moxa-cone is put on and lighted.Although cupping therapy has also been associated with Acupuncture, Tui Na and Moxibustion in TCM, ancient Egyptian Papyrus records dating back to 1550 BC has reference to cupping to remove foreign matter from the body.

Cupping is used mainly to treat arthritis and soft tissue injuries in the limbs; but also had previously been used for treating Bronchitis and Asthma. It is done by heating the inside of a glass cup to expel the air and placing the cup over the skin so, as the air in the cup cools, a vacuum is created to draw a portion of the skin into the cup. Naturally the cup has to be able to form an air-tight seal to achieve the vacuum needed. Suitable areas for cupping can be on level, smooth, fleshy skin surfaces such as calves, thighs, hips, buttocks, back, abdomen, chest, neck, forehead and temple.

Original cups were made from bamboo, but glass had become the ones used most commonly.

More recently manufactured cups are made of plastic and a suction pump of sorts used to withdraw air from an air exit point usually located at the top of the inverted cup.

Original cups were made from bamboo, but glass had become the ones used most commonly.

More recently manufactured cups are made of plastic and a suction pump of sorts used to withdraw air from an air exit point usually located at the top of the inverted cup.

Rules for cupping vary between different believes; most would use tender spots on the areas suitable for cupping, others use some acupuncture points, yet others cup over the area where the internal organ is situated (eg for Gall bladder problem cupping is done over the right upper quadrant of the abdomen). Some would take into consideration the phases of the moon, preferring a full moon to a new moon and even the time of day.Bruising and blistering can result from cupping treatment. There is not much quality scientific studies on cupping treatment and none has proven conclusively that cupping is efficient in treating any specific diseases. Some studies support cupping as a means of relieving some painful conditions but no definite evidence to support it to be as good as acupuncture. Again, I would look forward to more scientific studies on this mode of treatment.

"I have been wrong. The germ is nothing. The milieu is everything." - Louis Pasteur

Chapter 8 • Other scientific factors: in Healing and maintaining health

Acupuncture treatment has traditionally emphasised restoring a person's health, internal balance or harmony involving physical, mental, emotional and environmental factors.

Acupuncture's logo of Yin and Yang displays the belief that balance in life is important. So in using Acupuncture treatment other factors should be taken into consideration. These factors are well known to help in Western Medicine but are often neglected because of the powerful effect of some medicines. Moreover, practitioners of these other factors may tend to be restricted in their own discipline and emphasise the importance of their own discipline rather than integrating them into a total system of health maintenance. To that extent, the following are included with a brief description of why and how they can all be integrated to help. There are very complex processes going on in every part of the body, certainly too complicated for a total explanation of even one system in this book, so, as is intended in this book, look up areas which you want further information.

Other important scientifically proven factors: in Healing and Maintaining health include: 1. Food & Diets including Micronutrients and Probiotics 2. Exercise as an important factor in maintaining health

3. Emotional & psychological health • Stress, Anxiety and how they are dealt with.

4. Sleep Hygiene 5. Eliminate "poisons" to the body eg stop smoking, reduce alcohol, Avoid excess radiation esp UV, CT scans, radioactive substances 6. Spiritual Health 7. Environmental factors / Pollution • Conservation factors - keeping the world healthy benefits everyone

1) Food & Diets including Micronutrients and Probiotics Eating a balanced, varied diet is one of the most important factors in maintaining health. The body is in a constant state of building, repairing and removing waste. To maintain such important functions a diet with a good mix of proteins, carbohydrates, fat, fibre, vitamins and other micronutrients is important. For most people, when they eat, they assume the body will absorb all the good stuff we need in the food, without considering the quality and mix we consume.

This can be untrue due to the complexity of the digestive system also known as our Gastrointestinal tract (GIT). Poor dental hygiene and restricted salivary flow are the beginnings of problems besieging the GIT. Swallowing problems and loss of appetite can also affect what types of foods and how much a person would eat.

Disruption of acid or enzyme secretion in the upper GIT or alterations of GI muscle movements, called peristalsis, or reduction in the beneficial organisms in the colon can all cause serious diseases What about the food?

As a general rule, the body needs a wide mixture of food. Proteins are needed to replace damaged or lost proteins, and carbohydrates to burn as quick energy. Fats take longer to digest and need a chemical called Bile produced by the liver to emulsify into smaller droplets so that the Pancreatic Enzyme called Lipase can help digest it. So fats are for longer term use; as well, fats help in the absorption of certain vitamins (Vitamins A, D, E and K). Micronutrients which include Vitamins, essential fatty acids and other minerals are also needed in small amounts. In general, the body requirements of these nutrients are in the order of less than 1 gm a day. Although it seem to be a minute amount, the modern diet of over consumption of processed and packaged foods and poor cooking methods may cause deficiencies over time and eventually cause illnesses. Other food ingredients include fibres, which, although having no nutritional value on their own, are important for lowering Cholesterol and the risk of colon cancer as well as preventing constipation; the colon's peristaltic movements need fibres in the colonic lumen to function properly. In the past, the colon

was regarded as simply a store for waste matter after digestion, but research has shown the colon has a lively and complex ecosystem of billions of beneficial organisms all helping to maintain our health. These organisms help in the digestion of complex carbohydrates, actually manufacture some nutrients like Vitamin K and protect the colon from being colonised by pathogenic organisms.

Evidence is accumulating that these beneficial organisms also help protect the colon from inflammation, a process called "down-regulation of intestinal inflammation". Present studies are being done to find evidence to support the present indications that these organisms can actually promote a healthy body immune system. The prolonged use of certain antibiotics can upset the colonic organisms enabling pathological organisms to take over causing problems. Even without antibiotic use, any intestinal disruptions like severe diarrhoea could upset the bowel flora in a big way.

Probiotics are live organisms which can be ingested to provide health benefits to the host. By natural process, the gut organisms are in a constant state of change, so Probiotics only colonise the bowel temporarily and therefore need to be taken regularly, especially after any colonic disruptions, to maintain any positive effects it gives.

At present Probiotics can also be used to prevent traveller's diarrhoea, antibiotic induced diarrhoea and prevention of necrotizing enterocolitis, as well as some atopic diseases. Necrotizing enterocolitis is the death of the lining tissues of the intestine the cause of which is uncertain, but may be linked to disruption of intestinal circulation or bacterial infection; this condition affects premature infants or sick newborns primarily.

Prebiotics are food ingredients which when ingested help the growth or activity of the normal, healthy microorganisms in the bowel. Some examples are Inulin, Beta glycans and oligosaccharides. Food sources include legumes, like beans, some vegetables, like asparagus, chicory, leeks, onions and spinach and fruits, like bananas, and most berries.

2) Exercise Exercise is the next big factor. There are lots of scientific papers demonstrating the benefits of regular exercise not just in general fitness but including improving heart and lung function, helping the lipid profile both in cholesterol and triglyceride, improving hypertension, prevention of obesity and diabetes, helping insomnia and even improving people with depression. However there is a limit and people can overdo exercises and develop injury and illnesses.

When doing exercises, be mindful that exercises should be performed to help in the following 3 ways:

1) improve cardio-vascular health thus improving a person's stamina, 2) build muscular strength, and 3) improve flexibility.

When done properly, health and weight would approach the desired outcome.

In the category of exercises, the Chinese practice of Qi Qong (pronounced Chi kung) of which Tai Chi (full name Tai Chi Ch'uan) is a "dynamic form", has been linked to Acupuncture. Qi Qong

is represented by two Chinese characters: Qì (氣) and Gōng (功). The Chinese definition for "Qi" is air or vapour and is linked with 'breathing' but as described in earlier chapters, Qi can be used in describing the relationship between matter, energy and spirit. Qi in "Tai Chi" is also used in martial arts "Kung Fu" as a focus point in generating energy.

The word Qong denotes power. The two words, QiQong, combined describe the exercises done which concentrates on generating the power of breathing and energy circulation to improve physical, mental and spiritual health. There are different forms of QiQong exercises as practiced by different societies in China; some are practiced by the 'closed school' methods where the master only passed his knowledge to personally selected students.

Some such schools are reputed to produce practitioners of QiQong with not simply good health and enlightenment, but also extraordinary powers. It is this aspect of QiQong that had attracted criticisms and skepticism of being secretive and unscientific.However, it had been estimated that there are over 200 million practitioners of QiQong in China by early 2000 The popular form of Tai Chi, typified by extremely slow movements and various "stances" is generally a safe form of exercise to take up. Part of the benefit comes from the mind focusing on the slow movement and the "stances" helps bring about mental clarity and calmness, but overall proven benefits include improving balance and flexibility with low impact exercises that avoids damage to joints. A small RCT of 66 people with fibromyalgia proved that those who did Tai Chi exercises did significantly better for pain and fatigue relief, improving depression and had better sleep than those who simply did stretching exercises and had "wellness education".

3) Emotional & psychological health Psychological wellbeing is a big factor in health. The psychological component of health involves both a consequence of a physical illness as well as a precipitator of physical illnesses. Surveys done have always shown a shortened life span as well as an increase in various diseases in patients with various chronic psychological problems including:

Depression, Loneliness Social Isolation Bereavement Stress

Stress, Anxiety and Depression are not only debilitating to the sufferer, but causes widespread harm to the interior milieu. Western medicine including psychological treatments are scientifically proven to help and have made a lot of difference to the sufferer but acupuncture has also been able to help promote calmness and even improve mood and can be used in conjunction with rather than as a replacement.

Someone with a severe psychological problem that is difficult to treat with conventional Western Medicine using Drugs and Psychological counselling may benefit from a combination of acupuncture, western medications and counselling; after all we would like the patient to receive treatments which will give the best results.

Part of the problem with stress, anxiety and depression is the associated lost of interest in food or in cooking, when someone has the above psychological problems; so carers must be aware to check the sufferer's nutrition.

Acupuncture had been used for people with anxiety, depression and to generally help "calming" the person so he or she can cope better with their other physical problems. In my practice now I always check with the patient whether they are feeling anxious or depressed and I needle the extra points to help if the patient is willing to have a go, after acupuncture treatment of their problem that he/she presented for treatment in the first place.

4) Sleep Sleep is another important factor in both physical and mental health maintenance. Although the amount of sleep needed per night various from individual to individual an average of six to eight hours is the healthy amount of sleep adult people need. Not just quantity, there is also the factor of quality of sleep. We all have experienced having spent eight or more hours "sleeping" in bed but still waking up feeling like we just finished a marathon.

If someone's sleep is disturbed either by "internal factors" like headache, muscle cramps, other severe pain, nausea and other abdominal upsets, mental worries and stress or by "external factors" like loud outside noises, an uncomfortable bed, extremes of hot or cold environment, that person may still wake up tired and feeling unrestful despite an "adequate number of hours sleep".

There are also a whole host of "sleep disorders like, sleep-walking, bad dreams and nightmares, snoring, etc. Problems are compounded when a person has a medical condition which upsets their sleep; examples are sleep apnoea, restless legs syndrome, breathing difficulties from asthma or emphysema, heart failure, prostate trouble, neurological disorders like Parkinson's Disease, Dementia and so on.

Excessive alcohol also has a negative effect on sleep quality. Sleep deprivation had been proven scientifically to cause mood disorders, mental functioning disruption cardiovascular disease as well as compromised immunity, leading to infections.Again with acupuncture treatment for any anxiety / depression the patient might have, the patient tend to report having a better night's sleep.

5) Eliminate "poisons" to the body The body gets a constant bombardment of damaging "poisons" Although generally able to overcome small amounts, constant attack would harm the body, especially the immune system.

Smoking is now widely known to be the cause of many diseases and excess alcohol can lead to widespread damage especially to the liver and the nervous system. Thus stopping smoking and reducing alcohol intake are important as part of treating most medical problems and certainly should be taken into account when having acupuncture. Also avoid excessive radiation especially UV from the sun or too many CT scans. Again a balance is needed, as lack of sun exposure can lead to Vitamin D deficiency resulting in Osteoporosis as well as increasing the risk of cancer.

6) Spiritual Health Spirituality may be providing a "resilience factor" to illness and recovery and should be used to advantage to help someone in sickness and pain Interestingly, such a factor is not normally promoted as part of a complete holistic approach; in Western Medical Science the "Spirit" is so indefinable that it forms no part of the mechanistic explanations of body functions and illnesses.

When we talk about the "Human Spirit" it is a nebulous concept. We all know what we mean when we say someone has a great spirit although not measurable. Near-death experiences also has brought out some strange unexplainable phenomena about the spirit. One that came to mind was the true story of the strange experience of a person who had a cardiac arrest and got resuscitated back to life. That person was able to relate accurately the events and happenings during the period he or she was supposed to be dead. There are now retrospective scientific studies of such experiences collected by an organisation known as Near Death Experience Research Foundation (NDERF) If I may speculate, the mysterious Chi may be considered as a component that make up the "spirit", so spiritualism can affect the Chi and thus our health

7) Environmental factors / Pollution

We all live in a closed ecosystem that has seen increasing pollution daily. If every person makes an effort to reduce pollution and to recycle as much as possible, we will all be better off in the long term and we will be able to keep our planet beautiful for the next generation.

One unexpected " environmental pollution" is antibiotics over usage. When Penicillin was discovered it was like a "miracle cure-all" for infections. Unfortunately over the years, due to Antibiotics overuse, resistant strains have emerged, they are bacteria which have learnt to survive the antibiotics and managed to pass on that survival gene to other bacteria. Nowadays "superbugs" have become prevalent, two examples of which are Methicillin-Resistant

Staphylococci (MRS) and Vancomycin Resistant Enterococci (VRE) Antibiotics widely used in the food industries eg chickens fed with hormones and antibiotics also have been linked as a contributing factor to antibiotic resistance developing in bacteria.

Finally, I would like to say:

UNCOMMON TERMS & ABBREVIATIONS USED IN THIS BOOK A • Anaphylactic reaction - An allergy reaction that occurs within seconds or minutes after exposure to certain foreign substances, such as drugs and medications as well as other agents including latex, insect stings (bee, wasp, yellow jacket, hornet), or foods.

• Anecdotal evidence - Evidence based on hearsay • Atopic diseases - allergy diseases pertaining to a tendency to experience immediate allergic reactions, eg asthma or vasomotor rhinitis because of the presence of an antibody (atopic reagin) • Autoimmune diseases - Disease of the immune system where some the body's own healthy cells are treated as "foreign" and are attacked by the immune system.

C • Canthus - The part of the eye at both sides describing the angle formed by the meeting of the upper and lower eyelids.

• Cerebrospinal fluid (CSF) - Fluid within the brain and spinal column which both protects the nerve tissues and transport various chemicals throughout the central nervous system • Complement Deficiencies - Rare mostly autosomal recessive inherited immunodeficiency resulting in recurrent infections and autoimmunity • COX-2 - Cyclooxygenase 2 enzyme inhibitor - a newer class of anti-inflammatory medicine with less gasto-intestinal side effect than traditional "NSAID" anti-inflammatory medicines. More information regarding this class of medicines can be found in Wikipedia http://en.wikipedia.org/wiki/COX-2_inhibitor D • Diuretics - A class of medications that promote fluid loss; generally also has effect of lowing blood pressure • Endorphins - The group of peptide hormones found mainly in the brain. Endorphins reduce the sensation of pain and affect emotions by binding to opiate receptors.

H • Hypertension - High blood pressure • Hypothalamus - The part of the brain below the thalamus, forming the major portion of the ventral region of the diencephalon; the hypothalamus functioning to regulate bodily temperature, certain metabolic processes, and other autonomic activities.

I • Inhibitory cells - Nerve cells within the spinal cord which inhibit activation of transmission cells • Inter-Costal space - the space between ribs • Interstitial Nephritis - This is a kidney disorder in which the spaces between the kidney tubules become inflamed. The inflammation can affect the kidneys' function and can lead to kidney failure if untreated.

L • Lateral - The outside, away from the midline of the body Mediial - The inside, closer to the midline of the body • Majora labia -(Labia majora): The larger (major) outside pair of labia (lips) of the vulva of

the female external genitalia.

M • Metaflammation - which basically refers to an underlying low grade systemic

inflammatory process that basically goes unnoticed, but progressively destroys the body and leads to metabolic diseases such as coronary heart disease, diabetes etc • Micronutrients - Selected vitamins and trace elements which are supposed to strengthen the body's immune system • Myxoedema - A serious medical problem caused by decreased activity of the thyroid gland in adults resulting in lower basal metabolic rate, dry skin, swellings around the lips and nose as well as mental deterioration.

• Myxoedema Coma - Myxedema coma is state of decompensated hypothyroidism. This rare but dangerous condition may present with symptoms of altered mental status, hypothermia, hypoglycemia, hypotension, hyponatremia, bradycardia, and hypoventilation.

N • Naso - pertaining to the nose • Necrotizing enterocolitis - This is a severe disease of the intestine, involving the death of intestinal tissue. It primarily affects premature infants or sick newborns.

• Neurovascular bundles - Combination of nerve tissue and blood vessels.

• Nociceptors - Nerve sensory receptors activated by noxious stimuli, stimuli that can cause tissue damage O • Organs (Fu): Large Intestine, Stomach, Small Intestine, Urinary Bladder, "Tripple Warmer" and Gall Bladder

• Organs (Zang): Lung, Spleen, Heart, Kidney, Pericardium and Liver • Orbital margin - Rim of eye socket P • Pathogenic organisms - Organisms that tend to cause illness * * * • Pericardium - In Western Medicine it is the lining surrounding the heart and not regarded as a separate "organ" • Placebo - an inactive substance used as a "control" in an experiment to test the effect(s) of an active substance, but may produce a slight positive effect • Pneumothorax - Deflation of the lung due to air getting into the space between the lung and the rib cage • Probiotics - Beneficial bacteria, which, on ingestion, helps the body maintain health • Proton pump inhibitors (PPIs) - These are a group of drugs whose main action produce a very pronounced and long-lasting reduction of gastric acid production; thus are commonly used in Gastritis and Gastric and Duodenal Ulcer treatment.

Q • Qi - Pronounced "Chi" term used in Traditional Chinese Medicine; refers to the circulating energy force within acupuncture channels • Quantum physics - This is a branch of science that deals with discrete, indivisible units of energy called quanta as described by the Quantum Theory.

S • Sanjiao - also known as Triple Warmer • Severe Combined Immunodeficiency - Rare inherited childhood immunodeficiency problem, with deficient T and NK cells, that can lead to severe infections and early death T • Tragus (of ear) - The tragus is the small pointed swelling of the external ear, situated in front of the ear canal.

• "Transmission cells - Nerve cells within the spinal cord which passes on signals as pain if overstimulated past a critical level • Triple Warmer - Also known as Sanjiao in Acupuncture.

V • Visual cortex - This is that part of the cerebral cortex (brain) responsible for processing visual information. It is located in the back of the brain in an area called the occipital lobe.

W • Wiskott-Aldrich Syndrome - Rare X-linked inherited childhood immunodeficiency resulting in recurrent infections, low platelets and eczema Y • Yang (light) - The opposite of Yin • Yin (Dark) - The opposite of Yan ACRONYMS: EBM - Evidence Based Medicine LASER - Acronym for Light Amplification by Stimulated Emission of Radiation MRI scan - Magnetic Resonance Imaging scan NSAID - Non-Steroidal Anti-Inflammatory Drug PET scan - Positron Emission Tomography scan RCT - Randomised controlled trials - very important in Western Medicine Trials TCM - Traditional Chinese Medicine WHO - World Health Organisation

In closing Dr. Ling would like to personally thank you, the reader, and his Alcare team for the production of his ebook.

It is Dr. Ling's genuine hope that he can make a difference by examining the popular eastern and western sciences and examine how through science much can be gained for the patient.

Alcare also has its own website at http://www.alcare.net through which Dr. Ling hopes you will keep in touch. A blog allows for you to ask any questions that you may have.

Alcare looks forward to a future of discovery together and above all, the growth of your well-being.